individual and family health insurance plans - mercycare

individual and family health

insurance plans

CALL TODAY: (800) 895-2421 MercyCare has a plan for you.

Live well. We’ll insure you do.

MercyCare’s individual health plans are backed by

a company that’s been helping people like you stay

healthy for over 20 years. MercyCare provides quality,

affordable health insurance for health care services

close to home.

We are proud to say that MercyCare, as part of Mercy

Health System, received the Malcolm Baldrige National

Quality Award, the nation’s highest presidential honor

for quality and organizational performance excellence.

Did you know that MercyCare:

• Has an open access network, meaning no referrals

are needed for in-plan services?

• Provides you access to more than

400 medical professionals?

• Has local customer service to assist you?

• Manages over 40,000 members?

• Is one of the largest HMO plan providers in the area?

About us

To see more of what MercyCare Health Plans has to offer,

visit MercyCareHealthPlans.com.

Green Rock Walworth

Jefferson

Watertown

Lake MillsJohnson Creek

Jefferson

Fort AtkinsonCambridge

Whitewater

Delavan LakeGeneva

Beloit

Janesville

Brodhead

EvansvilleMilton

Edgerton

Crystal Lake

McHenry

Barrington

McHenryHarvard

Woodstock

*

Sharon

Walworth

H

H

H

H

H

Illinois

If you are looking for a provider, MercyCare Health Plans offers a complete, up-to-date listing of our physicians, clinics and pharmacies at MercyCareHealthPlans.com.

To locate a participating provider, follow these simple steps:1. Visit MercyCareHealthPlans.com2. Click on the “Find a Doctor” box on the home page3. Select your plan or enter your group number4. Search by location, specialty or name

A printed copy of our provider directory is also available upon request.Please call MCHP at (800) 895-2421 to have a copy sent to you.

*Where applicable. Not all providers are available on all plans.See your provider directory for plan providers.

finding a provider

24-hour emergency careMercy Hospital and Trauma Center1000 Mineral Point Ave.Janesville, WI 53548(608) 756-6000 (800) 756-4147

Mercy Walworth Hospital and Medical CenterN2950 State Rd. 67Lake Geneva, WI 53147(262) 245-2230

Mercy Harvard Hospital901 Grant St.Harvard, IL 60033(815) 943-5431

Fort HealthCare, Inc. Fort Memorial Hospital611 Sherman Ave. EastFort Atkinson, WI 53538(920) 568-5000

Watertown Memorial Hospital125 Hospital Dr.Watertown, WI 53098(920) 262-4210

Mercy East Urgent Care3524 E. Milwaukee St.Janesville, WI 53546(608) 756-8484Monday-Friday, 8 am-8 pm Saturday-Sunday, 9 am-5 pmInQuicker

Mercy South Urgent Care849 Kellogg Ave.Janesville, WI 53546(608) 755-7960Monday, Wednesday, 8 am-7 pm Tuesday, Thursday, Friday, 8 am-5 pmSaturday, 8 am-noon

Mercy North Urgent Care3400 Deerfield Dr.Janesville, WI 53546(608) 314-3605Monday-Friday, 7 am-9 pm Saturday, Sunday, holidays, 9 am-9 pm InQuicker

Mercy Mall Urgent Care1010 N. Washington St.Janesville, WI 53548(608) 741-3800Daily, 7 am-7 pm, Closed holidaysInQuicker

Mercy Beloit Urgent Care2825 Prairie Ave.Beloit, WI 53511(608) 363-5500Monday-Friday, 5-8 pm Saturday, 8 am-1 pm

Mercy Walworth Urgent CareN2950 State Rd. 67Lake Geneva, WI 53147(262) 245-2230Monday-Friday, 8 am-8 pmSaturday-Sunday, 9 am-1 pm

Mercy Whitewater Urgent Care507 W. Main St.Whitewater, WI 53190(262) 473-0401Monday-Friday, 5-9 pm Saturday, 9 am-2 pm

Fort HealthCare Lake Mills Urgent Care200 E. Tyranena Park Rd.Lake Mills, WI 53551(920) 648-3113Monday-Friday, 5-8 pm Saturday, 8 am- 8 pmSunday, 10 am-8 pm

Fort HealthCare, Inc. Fort Memorial Hospital-Urgent Care611 Sherman Ave. EastFort Atkinson, WI 53538(920) 568-5330Monday-Friday, 5-11 pm Saturday, Sunday, holidays, noon-11 pm

Watertown Memorial Hospital Urgent Care(located outside emergency department)806 Schuman Dr.Watertown, WI 53098(920) 262-4222Daily, 10 am-8 pm

Mercy McHenry Immediate Care3922 Mercy Dr.McHenry, IL 60050(815) 578-2020Monday-Friday, 8 am-8 pmSaturday, 8 am-6 pm, Sunday, 8 am-4 pm

Mercy Woodstock Immediate Care2000 Lake Ave.Woodstock, IL 60098(815) 337-1544Daily, 8 am-6 pm

Hospitals

Immediate care

Urgent care

When it comes to safeguarding your health, MercyCare Health Plans givesyou access to a network of top Mercy Health System specialists right here at home, so it’s easy to get the care you need, when you need it.

Mercy offers over 150 specialty services that range from the most basic tothe highly complex. Right here at home, our patients receive the higheststandard of care, including:

Quality, affordable health care … close to home

Verified Level II emergency trauma

Certified primary stroke care

Cardiac catheterization labs 24/7

Certified heart failure care

Certified chest pain care

Accredited cancer care (radiation and chemotherapy)

Accredited joint replacement care

Radiology department staffed 24/7

MD-1 emergency response vehicle

ICU critical care physician coverage 24/7

Neurosurgery physician coverage 24/7

Orthopaedic physician coverage 24/7

Plastic surgery physician coverage 24/7

InQuicker for emergency and urgent care

And so much more

MercyCare My Plan – Manage your health insurance onlineWith MercyCare My Plan, you can view your benefits, claims and eligibility, request additional ID cards, change your primary care provider, ask questions and so much more.

Visit MercyCareMyPlan.com to log it.

Mercy MyChart – Your health record. At your convenience.As a MercyCare member, you have access to Mercy MyChart, your online medical record.

• Review your medical history• Schedule appointments• Send messages to your provider• View test results• Request prescription refills• Print your child’s immunization records• And more

Get the app or visit MyChart.MercyHealthSystem.org

frequently asked questions

Why should I have health insurance?• No one plans to get sick or hurt, but most

people need medical care at some point.MercyCare Health Plans’ individual plans cover many of your expected and unexpected health care costs, andprotect you from very high expenses.

• Health insurance is a contract between you and MercyCare Health Plans. You buy a plan that best meets your needs, andMercyCare Health Plans pays part of yourmedical costs when you get sick or hurt.

• There are other important benefits ofhealth insurance. MercyCare’s individualplans provide free preventive care, vaccinations, screenings and check-ups.We also provide prescription drug coverage.

Do I have to have health insurance?If you don’t have coverage in 2015, you’ll paythe higher of these two amounts:• 2% of your yearly household income.

(Only the amount of income above the tax filing threshold, about $10,000 for anindividual, is used to calculate the penalty.)The maximum penalty is the national average premium for a bronze plan.

• $325 per person for the year ($162.50 perchild under 18). The maximum penalty perfamily using this method is $975.

You’ll pay the fee on the federal income taxreturn you file for the year you don’t havecoverage.

Can I keep my doctor?If you currently see a Mercy doctor, you can continue to see him/her by choosing a MercyCare plan. Please note that differentplans have different networks and providers.Networks include health care providers that aplan contracts with to take care of the plan’s members. Depending on the type of policy you buy, care may be covered only when you get it from a network provider. When comparing MercyCare plans in the Marketplace, you will see a link to the list of providers in each plan’s network.

What if I have a pre-existing condition?Whether you need health coverage or have italready, the health care law offers new rightsand protections that make coverage fairerand easier to understand. Essential healthbenefits for pre-existing medical conditionsare covered under all Marketplace plans. Noinsurer can reject you, charge you more, or refuse to pay for essential health benefits for any medical condition you had before yourcoverage started. MercyCare plans do notcontain exclusions for any pre-existing conditions.

What do essential health benefits include?• Ambulatory patient services (outpatient careyou get without being admitted to a hospital)

• Emergency services• Hospitalization• Maternity and newborn care (care before andafter your baby is born)

• Mental health and substance use disorder services, including behavioral health treatment(this includes counseling and psychotherapy)

• Prescription drugs• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditionsgain or recover mental and physical skills)

• Laboratory services• Preventive and wellness services and chronic disease management

• Pediatric services

Essential health benefits are minimum requirements for all MercyCare plans.

What is the health insurance marketplace?• Also sometimes called the Exchange, the Marketplace is a new way to find health coverage that fits your budget and meets yourneeds. With one application, you can see all your MercyCare options and enroll.

• When you use the Marketplace, you’ll fill out an application and find out if you can get lowercosts on your monthly premiums for privateMercyCare insurance plans. You’ll find out if you qualify for lower out-of-pocket coststhrough Medicaid or the Children’s HealthInsurance Program (CHIP).

How do I find out if I qualifyfor assistance?When you buy health insurance coverage in theMarketplace, you may be able to get a premiumtax credit that lowers what you pay in monthlypremiums. This will depend on your 2015 household size and income.

You can apply part or all of this tax credit each month to your premium payments. The Marketplace will send your tax credit directly to your insurance company, so you pay less foryour premiums each month.

The Federal Poverty Level (FPL) is the measure ofincome level issued annually by the Department of Health and Human Services. Federal povertylevels are used to determine your eligibility forcertain programs and benefits. If your 2015 incomefalls within the following ranges you’ll generallyqualify for a premium tax credit. The lower yourincome is within these ranges, the bigger yourcredit. To see the ranges turn to page 10.

Call a MercyCare sales representative at (800) 895-2421 to see if you qualify for additional premium assistance.

What is Cost Sharing Reduction (CSR)? A discount that lowers the amount you have topay out-of-pocket for deductibles, coinsurance,and copayments. You can get this reduction if youget health insurance through the Marketplace,your income is below a certain level, and youchoose a health plan from the Silver plan category

If your income is at least 100 percent and notmore than 250 percent of the Federal PovertyLevel, you are eligible for special plans with CostSharing Reductions to lower your out-of-pocketcosts, in addition to the Advanced Premium TaxCredits. Only the Marketplace can determine ifyou are eligible for, and how much you can receivein, Cost Sharing Reductions.

Find out more and apply atMercyCareHealthPlans.com.

Here are some definitions to help you understand insurance coverage:

• Premium: Premium is a fixed amount you pay to MercyCare Health Plans, usually everymonth. You pay this even if you don’t use medical care that month.

• Deductible: If you need medical care, a deductible is the amount you pay for care beforeMercyCare starts to pay its share. Once you meet your deductible, MercyCare begins tocover some costs of your care. Many plans provide preventive services, and sometimesother care, before you’ve met your deductible.

• Copayment: Copayment is a fixed amount you’ll pay for a medical service. For example, if your visit to the doctor’s office is $150 and your copay is $25, you pay $25 and MercyCare pays the remaining $125.

• Coinsurance: Coinsurance is similar to copayment, except it’s a percentage of costs you pay. For instance, you may pay 20% of the cost of a $100 medical bill. So you would pay $20 and MercyCare would pay the rest.

definitions to help

• Individuals with a household income under 400% will receive a tax credit(subsidy) to help pay monthly premiums.

• Individuals with a household income under 250% will receive a cost sharereduction which will reduce your deductible and maximum out-of-pocket.

• If you want to receive tax credit or cost share reduction, you need to purchase your individual MercyCare plan at healthcare.gov. (Please follow the steps on page 12.)

• If you don’t qualify or don’t want to receive a tax credit, you can purchase directly from MercyCare by calling (800) 895-2421.

Householdsize Percent of federal poverty line (FPL)

100% 150% 200% 250% 300% 400%

one $11,670 $17,505 $23,340 $29,175 $35,010 46,680

two 15,730 23,595 31,460 39,325 47,190 62,920

three 19,790 29,685 39,580 49,475 59,370 79,160

four 23,850 35,775 47,700 59,625 71,550 95,400

five 27,910 41,865 55,820 69,775 83,730 111,640

six 31,970 47,955 63,940 79,925 95,910 127,880

understanding income levels

How do I apply for Marketplace coverage?

• You can apply for health coverage, compare all your options and enroll in a plan in one streamlined applicationthrough the Marketplace.

• You can go to the Marketplace by visiting MercyCareHealthPlans.com and see the health coverage options available to you. Then you can compare plansside-by-side and choose a plan that meets your needsand fits your budget.

page 12

Set up an account. You’ll provide some basic information to get started, like your name, address and email address.

Fill out the online application. You’ll provide information about you and your family, like income, household size, current health coverage information and more. This will help the Marketplace find options that meet your needs.

Compare your options. You’ll be able to see all the options you qualify for, including private insurance plans and free and low-costcoverage through Medicaid and the Children’s Health Insurance Program (CHIP). The Marketplace will tell you if you qualify for lower costs on your monthly premiumsand out-of-pocket costs on deductibles, copayments and coinsurance. You’ll see details on costs and benefitsbefore you choose a plan.

Enroll. After you choose a plan, you can enroll online and decidehow you pay your premiums to your insurance company.If you or a member of your family qualify for Medicaid orCHIP, a representative will contact you to enroll. If youhave any questions, there’s plenty of live and online helpalong the way.

Ready to enroll? Call (800) 895-2421 or apply online at MercyCareHealthPlans.com.

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>>get health coverage in 4 steps

Key dates you’ll want to mark on your calendar:

Marketplace open enrollment has started• You can compare and select from the different insurance plans that MercyCare offers.• After reviewing your options, you can enroll in a plan that fits your needs and budget.• You’ll also learn if you can get lower costs on your health insurance before you enroll in a plan through Medicaid or the Children’s Health Insurance Program (CHIP).

January 1, 2015: Health coverage can start

• If you enroll in a MercyCare plan before December 15, 2014, and make your first premium payment, your new health insurance starts January 1, 2015.

• During the rest of open enrollment, if you enroll between the 1st and 15th day of themonth and pay your premium, your coverage begins the first day of the next month.So, if you enroll on January 10, 2015, your coverage begins February 1, 2015.

• If you enroll between the 16th and the last day of the month and pay your premium,your effective date of coverage will be the first day of the second following month. So, if you enroll on January 16, 2015, your coverage starts on March 1, 2015.

February 15, 2015: Open enrollment for 2015 health insurance ends

• Be sure to visit MercyCareHealthPlans.com or the Marketplace and enroll in a plan before this date.

When does this new health care insurance program take place?

We now have nine individual plans tailored to suit your needs and thoseof your family. The plans are laid out in metal tiers and detailed on pages 17-20.

Individual health plans offered through the Marketplace are grouped intofour metal levels (bronze, silver, gold and platinum) to help you compareplans. All health plans in the Marketplace get a metal designation basedon the level of cost-sharing. Cost-sharing refers to the costs that members share when they get medical care, such as a deductible and co-insurance.

*On average, the plan will pay this percentage of the total cost of the policy’s benefits. **If your income level is between 100% to 250% FPL, you might qualify for Cost-sharing subsidies to reduce out-of-pocket costs. Must enroll in Silver plan for cost-sharing subsidies shown on pages 19-20.

MercyCare has a plan for you!

OUT-OF-POCKET COSTS

Lower

Moderate

Higher

PLAN PAYS*

80%

70%

60%

METAL LEVEL

GOLD

SILVER

BRONZE

PREMIUMS

Higher

Moderate

Lower

Gold MercyCare HMO Gold Option A

Deductible $2,000 single/$4,000 family

Maximum out of Pocket $3,500 single/$7,000 family

Coinsurance 20% after deductible

Primary Care Visit $25

Specialist Visit $25

Preventive Services Covered at 100%

ER Visit $100

Urgent Care $35 In-network

Prescription Drug $20/$40/$60/25%

Silver MercyCare HMO Silver Option A







ER Visit $100

Urgent Care $35 in-network


Bronze MercyCare HMO Bronze Option A



Coinsurance 30%

Primary Care Visit 30% coinsurance after deductible

Specialist Visit 30% coinsurance after deductible


ER Visit 30% coinsurance after deductible

Urgent Care 30% coinsurance after deductible

Prescription Drug $20/$40/$60/25% after deductible

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MercyCare HMO Gold Option B MercyCare HMO Gold Option C

$1,000 single/$2,000 family $1,000 single/$2,000 family$3,500 single/$7,000 family $3,000 single/$6,000 family20% after deductible 20% after deductible$30 $30 $60 $60 Covered at 100% Covered at 100%$500 $250 $35 In-network $35 In-network$20/$40/$60/25% $10/$25/$50/25%

MercyCare HMO Silver Option B MercyCare HMO Silver Option C

$2,000 single/$4,000 family $3,000 single/$6,000 family$6,600 single/$13,200 family $6,350 single/$12,700 family30% after deductible 30% after deductible$30 30% coinsurance after deductible$60 30% coinsurance after deductibleCovered at 100% Covered at 100%$250 $500 $35 In-network 30% coinsurance after deductible$20/$40/$60/25% $10/$25/$50/25%

MercyCare HMO Bronze Option B MercyCare HMO Bronze Option C

$4,000 single/$8,000 family $6,250 single/$12,500 family$6,600 single/$13,200 family $6,250 single/$12,500 family20% 0%20% coinsurance after deductible No charge after deductible20% coinsurance after deductible No charge after deductibleCovered at 100% Covered at 100%20% coinsurance after deductible No charge after deductible20% coinsurance after deductible No charge after deductible20% coinsurance after deductible No charge after deductible

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Silver - Cost Share Reduction MercyCare HMO Silver Option A(100-150% FPL)

Deductible $0 single/$0 family

Maximum out of Pocket $500 single/$1,000 family

Coinsurance 0%




ER Visit $100



Silver - Cost Share Reduction MercyCare HMO Silver Option A (151-200% FPL)

Deductible $750 single/$1,500 family






ER Visit $100



Silver - Cost Share Reduction MercyCare HMO Silver Option A (201-250% FPL)







ER Visit $100



MercyCare HMO Silver Option B (100-150% FPL)

MercyCare HMO Silver Option C (100-150% FPL)

$50 single/$100 family $0 single/$0 family

$750 single/$1,500 family $1,000 single/$2,000 family

0% 10%

$15 10% coinsurance after deductible


Covered at 100% Covered at 100%

$100 $100

$35 In-network 10% coinsurance after deductible

$10/$25/$50/25% $10/$25/$50/25%

MercyCare HMO Silver Option B(151-200% FPL)


$250 single/$500 family $500 single/$1,000 family

$1,500 single/$3,000 family $1,500 single/$3,000 family

10% after deductible 20% after deductible




$250 $250

$35 in-network 20% coinsurance after deductible

$20/$40/$60/25% $10/$25/$50/25%

MercyCare HMO Silver Option B(201-250% FPL)




20% after deductible 20% after deductible




$250 $500

$35 in-network 20% coinsurance after deductible

$20/$40/$60/25% $10/$25/$50/25%

Call our office toll-free (800) 895-2421, or TTY for the hearingimpaired (800) 947-3529, Monday-Friday, 8 am-4:30 pm, Centraltime. Our sales representatives can answer your questions and make an appointment to discuss your individual needs.

Email us at [email protected].

Interested in attending a brief seminar?Visit MercyCareHealthPlans.com or call us at (800) 895-2421 to find out future dates.

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MercyCare Health PlansMercyCare Insurance CompanyMercyCare HMO, Inc.PO Box 550 Janesville, WI 53547-055 0

MercyCare Health Plans is a Qualified Health Plan issuer in the Health Insurance Marketplace.

individual and family health insurance plans - mercycare

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